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Having a conversation about risk
Jo: Welcome back! We’re now going to talk about how young people want you to approach a conversation about risk.
Jas: We understand that this can be a very daunting part of your job, but it is necessary. When done with empathy and kindness, it can actually be a really meaningful experience for us.
Jo: We want to mention that it’s important that you’ve already built the conversation and relationship before getting to this point. When you first meet someone, what you do, do not jump straight into the risk assessment. If you need help building your knowledge on establishing positive communication and trust, and how to have a safe conversation, check out some of the other guides on this site.
Jas: Hopefully you’ve already set up some expectations and goals for your conversation, and established some trust and communication standards. It’s important to continue these agreements throughout the conversation on risk.
Jo: You may have notes or history about the person that you are seeing. It’s important that you read the notes, but even more important that you don’t judge solely from them. We could be in a completely different place right now, so assess the current risk. Don’t focus on the future or the past.
Jas: Explain clearly about your confidentiality policy and make sure that we understand. Be honest about who you will be passing this information on to, and when. We understand that you have procedures that you must follow, so be transparent. If we feel that you have lied to us then this will break the trust that we have established.
Jo: If we have any physical injuries, of course, treat them, but remember that our psychological needs are equally as important, with or without these injuries.
Jas: Only treating physically injured young people sends the message that we need to escalate our behaviours in order to be worthy of care, and that we need to present a certain way in order to be taken seriously. This is a very dangerous message to send. Be conscious of this. Trusting us, listening and taking us seriously are all ways to ensure that things don’t continue to escalate.
Jo: Now it’s time to ask the risk questions. Make sure that you are clear and direct about what you are asking, and be careful not to ask multiple questions at once – this can be a way for us to avoid answering the difficult questions. Focus on one question and one risk factor at a time.
Jas: Even if we’ve been having an open and honest conversation up until now, it’s important that you don’t assume the level of risk – you must ask us.
Jo: Remember not to read off your sheet. Even if you have to ask a series of set questions, talk directly to us, whilst maintaining open body language and a calm tone of voice. If you come across as anxious or nervous, this can feed our own anxiety; potentially exacerbating or escalating the situation. You can find more information on this on other guides on our website.
Jas: Many people find simple yes or no questions the easiest to respond to, as it takes the pressure off of them. But it’s also important to acknowledge that an ‘I don’t know’ should be taken as seriously as a ‘yes’. And if you need clarification, you can always ask. And if ‘yes’ or ‘no’ questions don’t seem to be working, you could potentially open up the conversation a different way, by using a scale of 1 to 10 for a more nuanced discussion.
Jo: Remember that sometimes verbalising your thoughts and feelings can be challenging, especially for someone in crisis. Offer alternatives such as colour cards with emotions, or writing things down.
Jas: One essential aspect of assessing risk is assessing risk of suicide. We understand that it can be scary to bring up the word ‘suicide’. Sometimes this anxiety can lead to people phrasing it in a way that is up for interpretation, and this can get an unclear answer from young people.
Jo: Shying away from using the word suicide is actually really unhelpful. It reinforces and promotes the fact that it’s a shameful and uncomfortable topic, which it really doesn’t need to be! For many young people, expressing their feelings concerning suicide can be extremely meaningful, and actually helps us feel relieved.
Jas: Many of us actually find it helpful when someone asks us about suicide, or thoughts of suicide directly. It means we don’t have to come forward and divulge this massive secret; instead we can simply say yes, or no, or maybe, I don’t know.
Jo: Even if someone hasn’t attempted or has no physical injuries, suicidal thoughts and ideation must be taken very seriously. Many young people reported that their suicidal thoughts were dismissed or invalidated. This again pushes young people to feel that they have to escalate their behaviour further. A young person thinking about suicide is something that you must respond to, and it cannot be ignored.
Jas: If we are hesitant about opening up, try saying something like, “I need to know more about this so we can work together to find a solution.” Sometimes it feels like people assume that if you can’t articulate yourself properly in the moment, then it means you must be fine. But being in crisis makes it even harder to communicate. Don’t make that assumption. If the person seems unresponsive, they may be dissociating, or facing communication barriers. Work with us to communicate in a way that works, and give us ample time to express how we’re feeling.
Jo: Remember to give us time to elaborate. It shows us that you are genuinely willing to listen and have a healthy curiosity.
Jas: We understand that you have certain questions that you need to ask, but be open to us responding in a way that doesn’t fit into a tick box list, necessarily. Sometimes it’s hard to express what you’re going through or what you need because of the rigidity of the risk assessment lists. Be open to hearing what we have to say.
Jo: This can be a really challenging conversation, but, if done with care, empathy and respect, can be an incredibly meaningful and important interaction for us. We hope that some of the things that we’ve said help you understand things from our point of view.
As mentioned in our film, don’t conduct a risk assessment, before setting expectations and goals, explaining your confidentiality policy and establishing some trust and communication standards.
Although our notes or history are important, focus on here and now. Assess the current risk, not the future or the past.
Only treating young people with physical injuries, whilst ignoring psychological needs, can lead to escalated behaviour (self-harm) for young people to receive care.Trusting, listening and taking us seriously, are all ways to help prevent this from happening.
When it’s time to ask the risk questions. It’s important that you don’t assume the level of risk. Ask clear and direct questions, focusing on one question and one risk factor at a time.
Sometimes risk assessments can feel like a tick-box list. Bringing an open mind, open body language and a calm tone of voice to the conversation can help ease the pressure of ‘rigid’ risk assessment questions.
If ‘yes’ and ‘no’ questions don’t seem to be working, it might be helpful to ask, ‘on a scale of 1 to 10’. This can help open up the conversation and help us explore what we are experiencing.
Talking openly about suicide helps to tackle the stigma and anxiety around the subject. We might find it helpful when someone asks about suicide, or thoughts of suicide directly. It allows us to respond with a simple ‘yes, or no, or I don’t know’, and can feel like a relief to talk about it.
When you are in crisis it can be difficult to communicate. If the person you are speaking to seems unresponsive, they may be dissociating, or having communication barriers. Allow ample time for them to express what is happening. Phrases such as, ‘I need to know this so we can work together to find a solution’ and offering alternatives such as colour cards with emotions, or writing things down can be very helpful.
Remember to always give time for us to expand on our response. It shows us that you are willing to listen openly and care about us.
Using these insights, are there any ways you can approach your risk assessment questions to make them feel ‘less rigid?